Hatred as a contagious disease: a biopsychosocial-ecological framework for understanding hatred as a public health crisis

Has traditional medicine had its day? The need to redefine academic medicine

Averting A ‘Group Grope’ Response To Public Health Catastrophes

EditorialsSeptember 2023Preparing the United States for the Next PandemicFREEAshish K. Jha, MD, MPHAshish K. Jha, MD, MPHBrown University School of Public Health, Providence, Rhode IslandAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1894 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although SARS-CoV-2 infections continue to occur, the United States has exited the emergency phase of the pandemic. COVID-19 is manageable without major disruptions to the health care system and society. Effective COVID-19 vaccines and treatments are accessible to nearly all Americans (1–3). The current moment of recovery is an important time to reflect on what went right and what went wrong in this historic pandemic to learn how to do better next time. In this issue, the American College of Physicians (ACP) presents thoughtful recommendations of how we might do so (4).When we first became aware of SARS-CoV-2 in early 2020, our nation was clearly not adequately prepared for what was to come. This lack of preparedness has been decades in the making: The challenges ranged from poor funding of public health and inadequate crisis coordinating mechanisms to inadequate attention paid to critical supply chains and an information ecosystem that would require a novel approach to communicating with the public (5, 6).The ACP recommendations begin to meaningfully address those gaps, including the need for investments in public health, data infrastructure, effective communication strategies, and personnel. The Biden administration has begun this investment with substantial funds flowing to public health agencies, including the Centers for Disease Control and Prevention and local public health departments, to begin to fortify personnel and modernize data. Translating these resources into effective action will be critical.The strengthening of supply chains is another area of substantial progress. When President Biden came into office, the key parts of the supply chain for vaccines, personal protective equipment, and other essential equipment were weak. Through both investments and sustained focus, those have been largely repaired. However, clear challenges remain in establishing a robust supply chain for all essential medical and health-related products that can withstand shocks like a global pandemic. The shortages of essential medicines that plague the United States and other nations of the world are evidence of these persisting challenges.Although it is essential to recognize how our nation was ill prepared, it is also essential to recognize that which went very right. The position paper does this—identifying vaccine development and telehealth as areas of success. I want to note 3 areas where we saw some success and need to redouble our efforts: building on real innovations of the pandemic, addressing the information crisis, and strengthening integration of health care and public health.Sustaining and Scaling Pandemic InnovationsAs the ACP notes, the pandemic brought groundbreaking innovations. While telehealth is widely touted, and rightly so, a closely related innovation that received less attention is the "test-to-treat" programs that improved access to care in a range of communities and addressed issues of equity (7). For example, in New York City, mobile vans traveled to communities to provide people who had COVID-19 symptoms with rapid testing and treatment on the spot (8). Delivery innovations need to be scaled up beyond the context of COVID-19 as a model of care delivery for acute diseases where a trip to the physician's office or emergency department is neither needed nor feasible.Another notable pandemic innovation was Operation Warp Speed. Partnership and collaboration between the federal government, private sector, and academia were the key ingredients of this program which delivered highly effective, safe vaccines in record time. We should model this program to develop other vaccines and treatments where progress is too slow. The Biden Administration recently launched Project Next Gen to accelerate development of the next generation of vaccines and treatments for COVID-19 with the hope of creating a sustainable model for the development of vaccines and treatments against future pandemics (9).The Role of Physicians in the Response to the Health Information CrisisUnfortunately, we practice medicine and public health in a polluted information environment. The pandemic has shown that an overabundance of bad information contributes to negative health outcomes (10). A top-down, central communications approach is ineffective in today's networked information ecosystem. The time for one trusted voice to speak to 330 million Americans is over. Physicians and other health care professionals are trusted sources of information for millions of Americans. They must know how to evaluate evidence and engage diverse people in well-informed conversations about health. It will be critical for organizations like ACP to take a leadership role in training physicians to more effectively share good information. This does not require physicians to go on television or social media; Those who prefer offline engagement can share good information at town halls, school board meetings, and elsewhere in the communities they serve.Strengthening the Integration of Public Health and Health CareEven the best-funded public health system cannot respond to a major health crisis on its own. The U.S. health care delivery system had to step up to meet needs during this pandemic that public health could not adequately address; however, moving forward, we need to invest in building the partnership between public health and health care. What might this look like? It starts with greater data integration—health care data and public health data rarely communicate with each other. Breaking down these silos will be critical, as will breaking down the cultural divides that separate the health care and public health communities. The ACP identifies health care workers as a reserve force for public health crises. Beginning to use that health care workforce to address the public health crises that exist today—such as the mental health crisis and the opioid crisis—can begin to build the partnerships that will be essential the next time a pandemic hits.As we come out of the emergency phase of the COVID-19 pandemic, it is essential that we use the lessons learned to be well prepared for the next pandemic or other public health crises. If we do not, we risk sliding back to where things were in 2019. The choice is both stark and consequential. The ACP position paper offers thoughtful steps we must take to build on innovations and address our gaps in healthcare delivery and equity. We have made real progress on pandemic preparedness over the past 2 years. Now is the time to not just continue that work but accelerate it—to ensure that when the next health crisis hits, we are ready.

We certainly share Amadio’s view that public health has been underfunded for decades. We believe this situation is attributable in part to our nation’s propensity for prioritizing colossal military budgets over vital domestic and global public and environmental health programs. Consider, for example, the possibilities denied public health by the United States’ expenditure of approximately $5.5 trillion (in constant 1996 dollars) for nuclear weapons programs from 1940 through the late 1990s.1 We also agree that bioterrorism preparedness funding “is some of the first real new money that has come to public health in many years.” However, the impact of such appropriations, useful though they may be for limited improvements in communications and disease surveillance capacity, has been often constrained by strict restriction of their use to bioterrorism preparedness programs. These restrictions have left public health without adequate resources to meet fundamental needs. At the same time, public health has been stretched to the breaking point by ill-considered, dangerous programs such as the smallpox vaccination campaign, conducted in a climate of widespread state and local funding cuts.2 Reports heard at the 2004 annual meeting of the American Public Health Association3 and communications we have received from grassroots public health practitioners since our article appeared support this view. The reality of the current crisis in public health underscores the deficiencies of a bioterrorism-oriented public health model, compared with a model oriented toward prophylaxis and primary prevention of all forms of emerging and reemerging infectious diseases. The latter model could provide surge capacity to deal with new challenges4; for example, it could ensure an adequate annual supply of influenza vaccine. Improved communication among public health and other agencies is useful, but we must strictly avoid breaches of privacy based on mere suspicion of bioterrorism.5 A full evaluation of bioterrorism preparedness programs must weigh the putative benefits against the risks and adverse impacts of these programs, which Amadio does not mention. We would hope that any program oriented toward prevention of all potential biological threats would be comprehensive in scope and would address as a public health priority the potential threats posed by new developments in the biological sciences.6 A strong demand by public health leaders for development of the strongest and most stringent inspection and verification protocols for the Biological Weapons Convention, safeguards now spurned by the US government, would be a welcome change from the silence on this issue currently emanating from the Centers for Disease Control and Prevention. In this vein, all putative biodefense research programs must be made transparent and all potentially offensive programs halted as a bulwark against setting off a biological arms race that will seriously challenge any attempts at secondary or tertiary prevention.7,8 Thoughtful anticipation of future threats predicted to arise from global climate change9 should challenge us to move beyond heightened surveillance and vector eradication programs of the sort employed against West Nile virus to prevention strategies linked to the promotion of sustainable and renewable sources of energy.10

Pornography is being indicted as a public health crisis in the United States and elsewhere, but the professional public health community is not behind the recent push to address pornography as a public health threat. While pornography may not be contributing directly to mortality or acute morbidity for a substantial percentage of people, it may be influencing other public health problems, such as sexual violence, dating abuse, compulsive behavior, and sexually transmitted infections. However, the evidence to support pornography as a causal factor is mixed, and there are numerous other factors that have more strongly established associations with these outcomes of interest. Throughout history, repressive forces have inflated the charges against sexually explicit material in order to advance a morality-based agenda. Nevertheless, a public health approach and tried public health practices, such as harm reduction and coalition-building, will be instrumental to addressing the emergence of mainstream Internet pornography.

From drug prohibition to regulation: a public health imperative

In early 2020, public health workers across the United States were called to respond to an emerging threat: COVID-19. Seemingly overnight, COVID-19 became a pandemic and, as many transitioned from offices and schools to home-based settings, essential workers braved the risk of infection to face the emergency and maintain essential health services. The pace of the response and the scale of the loss of life in the United States were unprecedented in recent history. Public health workers demonstrated their dedication to their mission by rising to these challenges, often stretching themselves beyond their capacity to meet the demands of the crisis. In the months and years since the first case of COVID-19, there has been a seismic shift in the way society engages the public health workforce. The 2021 Public Health Workforce Interests and Needs Survey (PH WINS) provides a snapshot of the burden carried by the public health community. Even before the emergence of COVID-19, many public health workers have moved from one emergency response to the next with little pause for recovery, exacerbating systemic challenges. Our experience managing multiple simultaneous and overlapping public health emergencies has demonstrated the fragility of our public health infrastructure and eroded public trust. As we face an increasing frequency and severity of public health disasters in the contexts of climate change and organized health disinformation, a deepening distrust of science has forever changed the nature of our work. In addition, as the field of public health recognizes systemic racism as a public health crisis and takes meaningful steps to dismantle it, it is threatened with mounting hostility from outside and within our government structures. These experiences, reflected in PH WINS 2021, have also brought to light a world of opportunities to build a better public health system that will sustain through and beyond the emergencies of the future (Table). TABLE - Pathways to Resilience Build internal tracks to leadership for staff from communities that are heavily impacted in emergencies. Transform COVID-19 temporary public health workers into a new public health workforce. Develop a dynamic public health emergency response infrastructure. Build resilience in essential basic public health functions. Create trauma-responsive environments for the public health workforce. Build Internal Tracks to Leadership for Staff From Communities That Are Heavily Impacted in Emergencies The COVID-19 pandemic highlighted long-standing health inequities. Structural oppression creates community- and neighborhood-level health vulnerabilities before, during, and after public health emergencies1–3; however, the makeup of our current public health leadership is limited by generations of exclusion of people from the communities that could most benefit from public health programming. Historic definitions of expertise in public health exclude some of the most critical “qualifications”—those gained by lived experience. During the COVID-19 response, health departments in need of critical community-level information often did not have to look far; highly adept individuals from heavily impacted communities were already part of the public health workforce, but their indispensable skills and knowledge were not measured in their job titles or work assignments. Emergency responses can exacerbate or dismantle long-standing inequities perpetuated by systemic racism within governmental agencies. Public health must embrace the opportunity to unravel systems of oppression by identifying staff who live in the hardest-hit communities, uplifting them into leadership roles, and developing intentional partnerships with communities. Such approaches during emergency response can give staff the opportunity to gain leadership experience, develop skills in rapid participatory action research and qualitative methods, and forge the robust partnerships with communities necessary to develop community-relevant solutions and meaningfully improve health equity.3 Transform Temporary Public Health Workers Who Worked in COVID-19 Into a New Public Health Workforce Public health emergencies create critical opportunities to invest in a dangerously underfunded system.4,5 Funding streams emerging after public health emergency responses should be invested in remediating the systemic challenges that prolong and exacerbate emergencies, particularly by building a workforce from impacted communities. During COVID-19, while rapid scaling of a temporary workforce resulted in public health gains, many workers hired through an influx of emergency funding were laid off as the response deescalated. For example, NYC Trace, the largest contact tracing operation in the country, rapidly hired thousands of New Yorkers at a time when unemployment was high and relatively safe remote jobs were scarce. Selective recruitment from highly impacted communities at that time increased the acceptability of services while both investing in impacted communities and cultivating a pool of trained public health workers.3 Unless these workers are reintegrated into the public health workforce, the field risks losing their newly gained expertise. Given massive workforce shortages experienced by public health departments across the country, decision makers could look to approaches adopted by global humanitarian response programs and the Public Health Corps and consider developing national assignments to fill short- and long-term gaps. Not only would this fulfill urgent, mounting workforce needs and support the development of the public health careers for many essential pandemic workers but this workforce would also bring greater community-centered knowledge and practice to the field, nationwide. Develop a Dynamic Public Health Emergency Response Infrastructure As we emerge from the acute phases of the COVID-19 pandemic, we have an opportunity to revisit the structure of our public health emergency response systems, building upon a strong backbone of essential public health competencies. Across the country, public health workers were reassigned from their day jobs to emergency roles, often for years on end. PH WINS 2021 shows that all public health program areas contributed at least 20% of their workforce time to COVID-19 response efforts.6 This approach creates gaps in ongoing public health activities, burnout among employees, and limited institutional memory to inform future emergencies. To be responsive, emergency response systems need long-term investments to modernize and improve core public health functions. There is a clear need to institutionalize lessons learned and quickly integrate corrective actions. During and after a response, innovation and accountability in “hotwashes” and after-action reports could support this process but only if evaluation is followed by swift, measurable action. The resultant dynamic response system would support the translation of knowledge and skills from one response to another and produce a more efficient allocation of public health resources toward foundational infrastructure required in emergencies and core public health services. Build Resilience in Essential Basic Public Health Functions COVID-19's devastating legacy exceeds its direct morbidity and mortality. As case counts exploded in early 2020, routine public health operations and health care services screeched to a halt. While organizations worked around the clock to create electronic versions of services previously provided in person and emergency response programs incorporated wraparound services, not all services translated effectively and not all people had the same access to digital platforms. This has resulted in unprecedented setbacks in disease prevention, social-emotional learning, education, chronic and acute disease management, life expectancy, and more. At the same time, we are not seeing any reprieve from public health emergencies. These 2 are not separate: widening gaps in our public health systems multiply the impacts of public health disasters when they hit.1–3 Public health agencies must build capacity in core public health functions including surveillance and accompanying data informatics, data and risk communication systems, and robust mental health infrastructure. Instead of skirting along the edge of staff capacity and shying away from innovative modernization of public health informatics, we must invest in core functions that will not only ensure continuity of basic public health services for all people in all places in the United States but also facilitate smooth pivots to emergency response activities that rely on these same competencies. Create Trauma-Responsive Environments for the Public Health Workforce None of these initiatives or investments can move forward if no one is around to make them happen. PH WINS 2021 shows the devastating toll the past few years have had on the public health workforce, with nearly one-third of the governmental public health workforce considering leaving their organization in the next year for retirement or other reasons.7 Sector-wide burnout and related behavioral health impacts must be addressed while building sufficient capacity to prevent this scale of trauma from recurring in the next disaster. However, trauma is complex, long-lasting, and impacted by culture and environment; mitigation requires awareness and understanding. Now is the moment to build trauma-responsive environments for the public health community. Trauma-responsive environments promote healing and wellness, allow public health workers to access services and space to process their experiences, and support workers to heal. They must be built on a foundation of accessible mental health supports and integrative care approaches, which will be critical to sustaining services long after pandemic recovery funding is exhausted. Behavioral health services can only be accessible if social stigma and other barriers are reduced across the field of public health nationally. Some of these barriers are explicitly embedded in licensing and board requirements, leave policies, and organizational culture.8 Similarly, just as systemic and structurally intersectional inequities persist, so too do historical and intergenerational trauma via oppression, racism, and prejudice. Meaningful action is needed to revise policies that prevent public health workers from accessing behavioral health services. We must do more than ask our workers to “power through” because the next disaster is looming. It is time to improve our systems and way of work to build a foundation for trauma-responsive care throughout disaster response and recovery.

ImportanceThe onset of the COVID-19 global pandemic highlighted the increasing role played by social media in the generation, dissemination and consumption of outbreak-related information.ObjectiveThe objective of the current review is...

This article argues that the EU response to the COVID-19 crisis follows a pattern much like its response to earlier public health threats. Though each time the EU commits to being prepared for the next cross-border threat to health, as the immediate crisis recedes, so does the momentum to build the necessary administrative capacity, leaving the EU unprepared to take a leadership role when the next public health crisis emerges. The literature on administrative capacity, identifies authority, autonomy, and resources as three crucial dimensions of administrative capacity. An examination of the efforts to build administrative capacity after several recent public health crises (SARS, Avian Flu, MERS and COVID-19) shows that the EU has made only modest progress in granting such capacity to its supranational agency, The European Center for Disease Prevention and Control (ECDC). Despite the claims that COVID-19 was a new level of public health threat that demanded supranational action, the EU response again seems to fall back into a familiar pattern of making minor adjustments.

Effectively addressing public health crises requires dynamic and nimble interdisciplinary collaborations across the translational spectrum, from bench to clinic to community. The Clinical and Translational Science Award (CTSA) Program hubs are uniquely suited to facilitate interdisciplinary collaborations across universities and academic medical centers. This paper describes the activities at the Columbia University CTSA Program hub to address a current public health crisis, the opioid epidemic. Columbia's CTSA Program hub led a three-phase approach, based on the Conceptual Model of Transdisciplinary Scientific Collaboration as described by Stokols et al.: (1) a university-wide planning and brainstorming phase to identify key leaders across many domains who are influential in addressing the opioid epidemic, (2) a campus-wide and community outreach to identify all interested parties, and (3) ongoing targeted support for collaboration development. Preliminary metrics of success are interdisciplinary collaborations and grant funding. We describe recent examples of how interdisciplinary collaboration, academic-community partnership, and pilot funding contributed to the development and funding of innovative interdisciplinary research, including the New York site of the HEALing Communities initiative. The processes are now being used to support interdisciplinary approaches for other translational public health issues.

While the mission of public health is to fulfill society's interest in ensuring a healthy society as "public health is what we, as a society, do collectively to assure the conditions for people to be healthy," the mission of public health law is to assist in the creation of those conditions. However, at times of disaster, threats or risks caused by dead bodies often cause dramatic media coverage and public panic, which incite the passage of emergency public health laws. The unfortunate result of such emergency public health laws mandating immediate dead body disposal, often through mass burial, is that proper identification of the deceased is severely hampered, and families are frequently precluded from experiencing the grieving process and are unable to bring closure to such a traumatic event. Are such emergency public health laws misinformed? Are the threats of dead bodies of disasters a threat to the public's health? Are the perceived public health threats of dead bodies merely a myth-or is their cause for justified concern? Such a rush to burial not only may add to the psychological distress of survivors but it also forbids them the opportunity of seeing their loved ones being treated with dignity and respect. Additional consequence of "emergency" mass burial legislation without proper identification include legal problems associated with inheritance, life insurance, remarriage of spouses, parenting of surviving children, and even the threat of diplomatic tensions between nation states resulting from burial of foreign tourists. Disaster medicine specialists are often called upon to comment to the media, advise governmental agencies, and console families, as to the disposition of dead bodies and to the existence of any public health threats caused by the accumulation of human cadavers. Because disaster medicine specialists play a vital role in preserving the public's health, and because public fears of spread of infectious disease often escalate paralleling the accumulation of dead bodies, disaster medicine specialists must be properly informed of the epidemiologic risks and public health issues that dead bodies of disasters may pose. The purpose of this article is to provide a foundation for disaster medicine specialists in properly advising governments, the public, media, and families regarding the risks and fears concerning the health hazards of human cadavers resulting from disasters.

Introduction: Newcastle disease is a highly contagious illness and one of the "notifiable illnesses" on the World Health Organization list for Animal Health (OIE) Outcome. There are constantly new cases being reported as new NDV isolates from around the world. Newcastle disease poses a significant global economic threat to the poultry sector, causing highly contagious and transmissible diseases in birds with huge food security threat among the weak and vulnerable developing and underdeveloped countries Aim: The aim of this article borders on bringing to light the risk of possible Newcastle disease outbreak in Nigeria due to increasing poor management of poultry farms and poultry waste product. Furthermore, it will also underscore and outline various ways which can be adopted to prevent this poultry disease which is of great public health, economic and food security protection importance. Method/Methodology: This is a systematic review of published research articles focusing on Newcastle disease, epidemiology, pathogenicity, transmission and factors that can play important roles in the possible outbreak of the disease in poultries. Studies reviewed comprise of cross-sectional, prospective, longitudinal and observational studies. The study approach follows the systematic review of peer-reviewed published articles as well as online publications and articles derived from various databases with search keywords relevant to the topic of discourse. Findings and Results: The findings in this study highlight the endemicity of Newcastle virus disease in various part of the country, and how the severity of the disease is influenced by host characteristics, viral properties, and environmental factors. The study pointed out critical evidence-based possible reasons that could promote a new round of Newcastle disease epidemic outbreak as a result of poor poultry management practices such as high bird densities, poor poultry infrastructure, lack of quarantine of sick birds, mixed species rearing, free range system of poultry, poor waste disposal, lack of expertise, and insufficient biosecurity outcomes. However, the lack of education and awareness among farmers exacerbates the problem, hindering preventive measures. The complexity is increased by difficulties with vaccination, unrestrained bird movement through trading with neighboring countries and interstate, and a lack of diagnostic facilities. The consequences of an outbreak extends beyond financial losses to potential disruptions in the poultry supply chain, food security risks, and public health concerns. Conclusion and Recommendation: The growing difficulties in poultry management methods increases the serious public health concern posed by a possible Newcastle Virus epidemic outbreak in Nigeria. A paradigm shift in poultry farming practices is necessary to address this problem. A comprehensive strategy that incorporates infrastructural development, regulatory frameworks, and education in order to strengthen the poultry industry is needed, so as to address and prevent the looming public health and food security crises that may break out from the above scenario

Two years after SARS-COV-2 was declared a public health emergency, global estimates of excess deaths from the Institute for Health Metrics and Evaluation indicate that 18·2 million people died due to the pandemic by Dec 31, 2021—three times higher than official records suggest. 100 million people have been plunged into extreme poverty by the pandemic, according to World Bank estimates. While the true burden of COVID-19 is being unravelled, is a mental health crisis being unmasked? The pandemic has exposed long-standing gaps and a global underinvestment in mental health care and prevention, disproportionately affecting young people and women.

The past 3 years have witnessed two Public Health Emergencies of International Concern—epidemics of Zika and Ebola virus. Both have shaken the societies they affected. What are the lessons for public health?

How to Manage a Public Health Crisis and Bioterrorism in Korea